Health Policy 79 (2006) 144–152 Health system factors impacting on delivery of mental health services in Russia: Multi-methods study David McDaid a,b,* , Yvevgeniy Aleksievich Samyshkin c , Rachel Jenkins d , Angelina Potasheva e , Alexey Nikiforov f , Rifat Ali Atun c a LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom b European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, United Kingdom c Centre for Health Management, Tanaka Business School, Imperial College, London, United Kingdom d WHO Collaborating Centre, Institute of Psychiatry, King’s College, London, United Kingdom e Chief Psychiatrist, Sverdlovsk Oblast Psychiatric Service, Ekaterinburg, Russian Federation f Deputy Minister for Social Protection, Sverdlovsk Oblast Ministry of Social Protection, Ekaterinburg, Russian Federation Abstract Objective: To evaluate how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of the Russian Federation. Methods: A multi-methods study was conducted including analysis of routine data and key informant interviews supplemented by analysis of published literature, legal and regulatory documents, ministerial orders and reports. Results: Mental health care services are still largely provided in hospitals, although the need for more community-based and rehabilitation services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain a large number of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation, but co-operation across sectors at local level is growing. Conclusion: In Russia, the pace of reform in the mental health system will be helped if financial resource allocation mechanisms and provider payment systems are also reformed, so that resources follow individuals regardless of where they are treated. Such major health system shifts can only be achieved through changes at the Federal level and require major political will. Additional transitional funding is also required to help develop the necessary alternative community-based services. The nature of mental health disorders mean that this is not a problem faced within the health system alone, greater attention needs to be placed also on how to maximise the cross sector benefits especially with the social protection and employment sectors. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Mental health policy; Health and social systems; Russian Federation; Healthcare organisation and financing * Corresponding author. Tel.: +44 207 955 6381. E-mail address: d.mcdaid@lse.ac.uk (D. McDaid). 0168-8510/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2005.12.014